First clinical nightmare

  1. I'm curious to know if other nursing students have had similar clinical experiences to my first one.
    I am in my 5th week of my ADN program and our program focuses extensively on Nclex style questions and the theory aspect is very subpar. As far as our skills go we have only been validated on med admin, vitals, and basic wound care.
    We arrive at the clinical site and our nurse instructor shows up and verifies our identities and brings us up to the IMC unit. We are each assigned a patient and told to wait outside of our patients door. Prior to this we have not received any other information from the school outside of just the clinical site and date/time. After waiting 10 minutes the instructor swings around the corner and asks what I am doing. I told her I was following instruction and waiting. It turns out the Nurse I was assigned to got report on the other end of the hallway and just went straight to the nurses station. So I missed report. Nice.
    I then go ahead and introduce myself to my patient and he was an elderly man admitted for a pressure sore in his sacral area. He was really pleasant and remained asleep the majority of the time I was there. Since we were on the IMC all of the patients were hooked up to monitors so I didn't have to do much to get their vitals. I assisted with his medications and went to check on the other students. Our instructor then grabs me and tells me to give another patient a bath. No problem. Just one thing. I have never been taught how to give a bed bath. I mean it surely wasnt hard but this is my first clinical experience I dont know what I can and cant do. I tell my instructor and she gives me a really confused look and says "They haven't taught you basic patient care?" I understood her frustrations but she clearly wasn't communicating with the school.
    She borderline throws me into a room with a patient on contact precautions (nice) and I awkwardly act like I know what I am doing until a tech visits and sees me struggling. She helps me out and I go on about my day. Fast forward 5 minutes and she sends me on a break. So I break with the other students and we talk about our day. The other students were working side by side with the nurses learning everything they are supposed to. My nurse was nowhere to be found at all in our hallway and I was mainly working with the instructor on random assignments all over the floor. After breaking I go back to my patients room and the wound care nurse is finished and is on her way out. My instructor walks by and asks if I got to see anything. I didn't and she basically said I should have come back sooner. Okay.
    Two of the other students in my class were assigned to a patient who got rushed to surgery. They were allowed to assist and watch for a couple hours but then came back. Our instructor asked them if she got a chance to perform her head to toe assessment. In my head Im going (wha wha wha whaaaaa?). We havent been taught how to do that. So they of course say no. Our instructor became so furious she grabbed them put them in a conference room and started yelling. These poor girls came out crying and I was just frozen because I knew I was in the exact same boat. So I go back to my patients room to try to basically get a general assessment but when I show up his wife had woken him up to feed and she told me he needed some time so I left. At this point our instructor gives us some papers that have body systems on there. Greaaaaat. This is our assessment form. She tells us to try to get as much patient info as possible. But there is biographical information on there like birthday and religion etc. I ask her if I can see the patients chart. She laughed and said "This is to test YOUR assessment skills, not your nurses." So I go back into my patients room and he is fast asleep and I notice his respirations dropped from 20 all the way down to 5 when I was last in there. I go see the nurse and she rushes in to see what's going on. I am then grabbed by my instructor and assigned to watch a procedure and fast forward 30 more minutes of random assignments I am told to give report on my patient and provide my assessment notes. This lady cut me off on every body system and told me I clearly didn't know what an assessment was. I told her I very much did not because we havent been taught that. She got snippy and said "Well what dooooo yall know?!". We all just kind of looked at each other and she said "Clearly not enough. I don't know how you're expected to pass this clinical if your docucare is submitted the same as your assessment notes here." She then tells us to leave and we all just kind of remain quiet until we get to our cars. It wasn't the smells, or the blood, or the wounds, or any of that which got me. But the embarrassment of being put there without any experience or information and being completely disorganized and rushed literally brought me to tears when I got in my car. So I'm not having any sort of existential crisis about this. I know nursing is hard. But I wanted to know if everyones program throws them to the wolves like that or if it was just us?
  2. Visit Flylik3abr1 profile page

    About Flylik3abr1

    Joined: May '18; Posts: 9; Likes: 3
    from AL , US

    28 Comments

  3. by   Triddin
    I find it shocking you're allowed in clinical and administering medications without having learned assessments. This school sounds kind of sketchy
  4. by   llg
    That is not the way it should be. It sounds like something is wrong with your school. Is there someone at the school you can talk to about this? Your clinical instructor should know what content you have received at this early point in your schooling and what content you have not yet received -- at the very least.
  5. by   Flylik3abr1
    @Triddin
    Our school is one of the top tier schools in my state for their NCLEX passing rate. It's almost 100 percent. However our program focuses primarily on critical thinking tests and problem solving questions rather than practical skills. Head to toe assessments are our last validations after NG tubes. I think it is ridiculous.
  6. by   rnhopeful82
    That's not normal at all. What did you do during your first 4 weeks? At my school, we were AT school for 3 weeks learning everything from proper hand washing, how to gown up and in what order, how to give bed baths and make an occupied bed, check vitals etc. Then we started at a nursing home for the first semester where patients were mostly stable and on routines. Even then we got to pair up for the first 2 weeks. We didn't give meds or check sugars til halfway through and that was with our instructor standing there helping us and asking us questions the whole time to aid us. I have no idea why your school would ever think the way they are doing it is appropriate or safe. If you haven't learned how to do a head to toe assessment, have you been taught the 6 rights of med admin? Seems one should come before the other, especially if certain meds need to be held for certain parameters. I'm also baffled as to why your instructor has no idea what is being taught at school. When we were learning at school, it was taught by our clinical instructors, who work close with our teachers to understand what we are learning in class and what we should be doing at clinical. Good luck with the rest of that crazy semester!
  7. by   Flylik3abr1
    @rnhopeful82 We were at school for 4 weeks learning hand washing, putting on gowns, and how to mix and administer medications but we had no open lab hours so any practice we got happened the day of the lab. We haven't had any sort of nursing home or geriatric care experience, we had one with a school nurse and then we were immediately thrown into the hospital. I never met my instructor before yesterday. The only instructors I have met are my current lecture instructor and the one for next semester. We receive no information about clinical aside from the location and day of. I had to email my teacher to get the time and unit. No idea about the 6 rights of med admin.
  8. by   broughden
    Quote from Flylik3abr1
    @Triddin
    Our school is one of the top tier schools in my state for their NCLEX passing rate. It's almost 100 percent. However our program focuses primarily on critical thinking tests and problem solving questions rather than practical skills. Head to toe assessments are our last validations after NG tubes. I think it is ridiculous.
    Our school is set up similarly.
    We learn our assessment system by system, we arent cleared for a full assessment until the end of the first semester.

    As for your clinical instructor, I would discuss what happened with your lecture professor. Clinical instructorship is a side gig for most of them or sometimes they are "thinking" about becoming professors. Your lecture professor is still overall in charge.

    Ive been told our school has even dismissed clinical instructors at the end of their first semesters due to not being a "good fit" (ie competent) for the program.
  9. by   pixierose
    Quote from Flylik3abr1
    @rnhopeful82 We were at school for 4 weeks learning hand washing, putting on gowns, and how to mix and administer medications but we had no open lab hours so any practice we got happened the day of the lab. We haven't had any sort of nursing home or geriatric care experience, we had one with a school nurse and then we were immediately thrown into the hospital. I never met my instructor before yesterday. The only instructors I have met are my current lecture instructor and the one for next semester. We receive no information about clinical aside from the location and day of. I had to email my teacher to get the time and unit. No idea about the 6 rights of med admin.
    No idea about the rights of med administration? Seriously?

    If I were a clinical instructor, I would be mighty upset ... 100% NCLEX passing rate or no. You'd be wasting my time, and the staff nurses time. Clinical is to practice skills learned.

    Maybe she went about it the wrong way, but ... you should know how how to do a health assessment. Vitals. Med administration, and the rights. These are BASIC skills. My school also taught these within the first four weeks ...

    Your school is failing you.
  10. by   broughden
    Quote from pixierose
    No idea about the rights of med administration? Seriously?

    If I were a clinical instructor, I would be mighty upset ... 100% NCLEX passing rate or no. You'd be wasting my time, and the staff nurses time. Clinical is to practice skills learned.

    Maybe she went about it the wrong way, but ... you should know how how to do a health assessment. Vitals. Med administration, and the rights. These are BASIC skills. My school also taught these within the first four weeks ...

    Your school is failing you.
    Yeah I didnt see their post about not knowing the rights of med administration until after I had already posted.
    While not knowing a full assessment makes sense (at least compared to my own program) not knowing the 6 rights of med administration by now seems extremely strange.
  11. by   missmollie
    No one knows everything going into their first clinical. You knew enough to check the respiration and notice a significant change, which is great! The next nurse you are assigned, ask to watch them do their assessment. See what they do and the order they go, and when they have time (and I emphasize time), ask them to go over how they assess their patient. You may have assessment videos that aren't assigned until later in the course. Try to go over that now.

    I work in neurosurgery, but we get trauma, vascular, and sometimes medicine patients. A basic good assessment for my patient population, focused on the brain, goes like this:

    Introduction of nurse to patient, and think about why they are there. What system do you need to focus on?: Hi, I'm _______, and I'm going to be your nurse (student nurse) today. I'm going to ask you some silly questions, so bear with me. Where are we? What month is it? What year is it? Who is the president? This is your glasgow score.

    You did great. Are you having any pain? Where is the pain, how long has that pain been there. What do you do at home to alleviate your pain? I'll be sure to talk to the nurse and see what we can do about that.

    Let me have a look at those pretty eyes. (Check pupils size, reaction to light). Think: Are they PERRLA? If you have to question if one is bigger than the other, then it's fine.

    I'm going to listen to your lungs (Just check lungs in whatever position they are in, four points, posterior or anterior doesn't matter). Does anything sound really off? Next, listen to the heart. Does it sound normal? Then listen to the abdomen. Think if they just recently had surgery, how many opioids they are taking, and is the bowel regimen the correct one. Take your stethoscope off your ears.

    Problem areas: Ask questions. Lungs sound odd? Ask if they are a smoker, do they have problems getting up and down steps, where do they sleep (If they sleep in a chair, it's to aid in breathing). If they are on oxygen, do they wear oxygen at home?

    Heart sounds weird? Do they have a scar on their chest (possible CABG), Any issues with the heart?

    Bowel: little to no bowel sounds? Ask when their last BM was. Ask anyway to ensure there isn't a problem. Ask if they have any issues with peeing.

    *While asking these questions, feel for pulses in wrists and AC area* While feeling for pulses, are the limbs warm or cold. Ask yourself if they are diabetic or not. Look at their skin. Is it normal, dry, bruised?

    Check the feet. Pulses good? Any numbness or tingling?

    Finally, ask if there is anything they would like you to know.

    Full assessment should take a beginner about 15 minutes. It takes me about 3 minutes. Practice on your fellow students, let them practice on you. Get the swing of it down so you go head to toe. Your "official" assessment at the school will take you half an hour, and that's okay. Learn from it, but most "real world" assessments can be done quickly.

    One last tip: try to make your patient be at ease during the assessment. IF you're listening to their heart, tell them that "Oh, that's good, it's still beating" with a little wink and move on. If you hear something, your patient shouldn't know it. Keep them at ease, and just work down the body.
  12. by   Kallie3006
    I don't remember for sure but I think we learned assessments around the last of the first semester. We were, however, quizzed like no tomorrow with medications and medication rights. This lead into the 3 checks for each med before administration. We also got our patient's information the day before clinical and had to write med cards on all their meds, plus care plans, lab values and possibilities for the value not being WDL. We also knew our instructors before clinicals and they were fully aware of the skills we knew and what we needed to be checked off on in the clinical setting. We were not allowed to do anything without our instructors and did not get nursing preceptors until that the last semester, or something to that nature.

    I have noticed now that the students that come to the facility I work at, hardly ever have their nursing instructor present and it us up to the staff the student nurses are assigned to, to include the nurses in the patient's activity etc that they have been assigned to. And then we have to fill out an eval on the SN that day.

    My advice, or what I would do if it were me in the situation you are in: see if your clinical group can meet with the lecture instructor after class or something, there is power in numbers. When talking to the lecture instructor, be professional and factual and inform of your day and the expectations the clinical instructor had, at this point I would inquire about a clinical checklist, something that has the skills you have been checked off on and need to be checked off on in the clinical setting. See what is suggested to do on your end to get the most out of the clinical experience that you can, this is the money that you are paying for this education

    When going to the unit and getting your assignment see who the nurse going off is and the nurse you will be working with, introduce yourself and let the nurse know what you need to try to do that day in relation to your skills. If you need to leave the unit or whatever, be courtious and let the nurse know. I personally will not go and hunt a student assigned to me- I want them to have the best possible experience and do or see things that they are allowed to, but I am not playing hide and seek, I am there to take care of the patient.
    Offer to help the nurse in whatever it is that you are able. And please, please, please ask the nurse taking care of that patient, before getting the patient food or water, getting the patient up, or bathing. There could be things that need to be down or precautions to take before tasks of that nature can be completed.

    I hope your next clinical experience is more productive and conducive to learning.
  13. by   hppygr8ful
    Well you are only five weeks in so I will reserve judgement for now because you haven't really had time to learn a lot. Still your school seems to be lacking in teaching the basics of patient care. I had an orientee with a BSN no less who came to me not knowing how to take vital signs as she had only ever used a machine. When I asked her what she would do if the machine was broken or in an emergency she had no answer. Our orientations are only 8 weeks long but by the end of the day she had it. Your whole class needs to meet with your lab instructor. I also suggest that You Tube has many assessments on video.

    Hppy
  14. by   NICU Guy
    Quote from Flylik3abr1
    Our school is one of the top tier schools in my state for their NCLEX passing rate. It's almost 100 percent.
    It is obviously one of those schols that say "you will learn clinical skills when you become a nurse." so, all the students pass NCLEX, but are clueless when they get to their first job and struggle because they don't have the basic clinical skills. That is why your clinical instructor was frustrated.

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